When you want to lift your arm or take a step, your
brain sends nerve signals to the appropriate
muscles. Internal organs like the heart and bladder
are also controlled by nerve signals, but you do not
have the same kind of conscious control over them as
you do over your arms and legs. The nerves that
control your internal organs are called autonomic
nerves, and they signal your body to digest food and
circulate blood without your having to think about
it.

Your body's response to sexual stimuli is also
involuntary, governed by autonomic nerve signals
that increase blood flow to the genitals and cause
smooth muscle tissue to relax. Damage to these
autonomic nerves is what can hinder normal function.

Sexual
Problems in Men With Diabetes

Erectile Dysfunction

Estimates of the
prevalence of erectile dysfunction in men with
diabetes range from 20 to 85 percent. Erectile
dysfunction is a consistent inability to have an
erection firm enough for sexual intercourse. The
condition includes the total inability to have an
erection, the inability to sustain an erection, or
the occasional inability to have or sustain an
erection. A recent study of a clinic population
revealed that 5 percent of the men with erectile
dysfunction also had undiagnosed diabetes.

Men who have
diabetes are three times more likely to have
erectile dysfunction as men who do not have
diabetes. Among men with erectile dysfunction, those
with diabetes are likely to have experienced the
problem as much as 10 to 15 years earlier than men
without diabetes.

In addition to
diabetes, other major causes of erectile dysfunction
include high blood pressure, kidney disease,
alcoholism, and blood vessel disease. Erectile
dysfunction may also occur because of the side
effects of medications, psychological factors,
smoking, and hormonal deficiencies.

If you experience
erectile dysfunction, talking to your doctor about
it is the first step in getting help. Your doctor
may ask you about your medical history, the type and
frequency of your sexual problems, your medications,
your smoking and drinking habits, and other health
conditions. A physical exam and laboratory tests may
help pinpoint causes. Your blood glucose control and
hormone levels will be checked. The doctor may also
ask you whether you are depressed or have recently
experienced upsetting changes in your life. In
addition, you may be asked to do a test at home that
checks for erections that occur while you sleep.

Treatments for erectile dysfunction caused by nerve
damage, also called neuropathy, vary widely and
range from oral pills, a vacuum pump, pellets placed
in the urethra, and shots directly into the penis,
to surgery. All these methods have strengths and
drawbacks. Psychotherapy to reduce anxiety or
address other issues may be necessary. Surgery to
implant a device to aid in erection or to repair
arteries is another option.

Retrograde Ejaculation

Retrograde ejaculation is a condition in which part
or all of a man's semen goes into the bladder
instead of out the penis during ejaculation.
Retrograde ejaculation occurs when internal muscles,
called sphincters, do not function normally. A
sphincter automatically opens or closes a passage in
the body. The semen mixes with urine in the bladder
and leaves the body during urination, without
harming the bladder. A man experiencing retrograde
ejaculation may notice that little semen is
discharged during ejaculation or may become aware of
the condition if fertility problems arise. His urine
may appear cloudy; analysis of a urine sample after
ejaculation will reveal the presence of semen.

Poor blood
glucose control and the resulting nerve damage are
associated with retrograde ejaculation. Other causes
include prostate surgery or some blood pressure
medicines.

Retrograde ejaculation caused by diabetes or surgery
may be improved with a medication that improves the
muscle tone of the bladder neck. A urologist
experienced in infertility treatments may assist
with techniques to promote fertility, such as
collecting sperm from the urine and then using the
sperm for artificial insemination.

Sexual
Problems in Women With Diabetes

Decreased Vaginal Lubrication

Nerve damage to cells that line the vagina can
result in dryness, which in turn may lead to
discomfort during sexual intercourse. Discomfort is
likely to decrease sexual response or desire.

Decreased or Absent Sexual Response

Diabetes or other
diseases, blood pressure medications, certain
prescription and over-the-counter drugs, alcohol
abuse, smoking, and psychological factors such as
anxiety or depression can all cause sexual problems
in women. Gynecologic infections or conditions
relating to pregnancy or menopause can also
contribute to decreased or absent sexual response.

As
many as 35 percent of women with diabetes may
experience decreased or absent sexual response.
Decreased desire for sex, inability to become or
remain aroused, lack of sensation, or inability to
reach orgasm can result.

Symptoms include:

decreased or total lack of
interest in sexual relations.

decreased or no sensation in the
genital area.

constant or occasional inability
to reach orgasm.

dryness in the vaginal area,
leading to pain or discomfort during sexual
relations.

If you experience
sexual problems or notice a change in your sexual
response, talking to your doctor about it is the
first step in getting help. Your doctor will ask you
about your medical history, any gynecologic
conditions or infections, the type and frequency of
your sexual problems, your medications, your smoking
and drinking habits, and other health conditions. A
physical exam and laboratory tests may also help
pinpoint causes. Your blood glucose control will be
discussed. The doctor may ask whether you might be
pregnant or have reached menopause and whether you
are depressed or have recently experienced upsetting
changes in your life.

Prescription or
over-the-counter vaginal lubricant creams may be
useful for women experiencing dryness.

Techniques to treat decreased sexual response
include changes in position and stimulation during
sexual relations. Psychological counseling, as well
as Kegel exercises to strengthen the muscles that
hold urine in the bladder, may be helpful. Studies
of drug treatments are under way.

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